MEDICARE: LUTHER C ROLLINS III MD III MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	023101	GA
2	207L00000X	Anesthesiology Physician	023101	GA
3	208VP0000X	Pain Medicine Physician	023101	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	023101	OTHER	GA	LICENSE
2	LICENSE	OTHER	GA	023101
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043228364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUTHER C ROLLINS III MD III MD

Provider Business Mailing Address
First Line	:	1140 HAMMOND DRIVE, NE
Second Line	:	BLDG D-4190
City	:	ATLANTA
State	:	GA
Zip	:	30328
Country	:	US
Telephone Number	:	770-558-8501
Fax Number	:	770-558-8512

Provider Business Practice Location Address
First Line	:	1140 HAMMOND DRIVE, NE
Second Line	:	BLDG D-4190
City	:	ATLANTA
State	:	GA
Zip	:	30328
Country	:	US
Telephone Number	:	404-351-1745
Fax Number	:	404-351-7121

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	09/28/2011

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